Using mHealth Tools to Improve Access and Coverage of People With Public Health Insurance and High Cardiovascular Disease Risk in Argentina: A Pragmatic Cluster Randomized Trial

Abstract

Background Control of cardiovascular disease ( CVD ) risk factors is suboptimal in Argentina, despite the government's provision of free blood pressure and cholesterol‐lowering medications for people without private insurance. We assessed whether community health workers’ use of an integrated mH ealth tool encourages patients to attend visits at primary care clinics to improve CVD risk management in 2 provinces of Argentina. Methods and Results We conducted a pragmatic cluster randomized trial, with primary care clinics randomly assigned to intervention or control. Eligible people were aged 40 to 79 years, lived in the catchment area of primary care clinics, possessed a mobile phone for personal use, had public health coverage, and a 10‐year CVD risk ≥10%. In the control arm, community health workers screened for CVD risk using a paper‐based tool and encouraged high‐risk people to present to the primary care clinics for care. In the intervention arm, community health workers used the mH ealth tool to calculate CVD risk and confirm a scheduled physician appointment. Primary outcomes were the proportion of participants who attended a baseline visit and completed at least 1 follow‐up, respectively. We enrolled 755 people (376 interventions; 379 controls). Intervention participants were significantly more likely to complete baseline visits (49.4% versus 13.5%, P value 0.0008) and follow‐up visits (31.9% versus 7.7%; P value 0.0041). The use of chronic medication and current smoking were significant predictors of primary outcomes. Conclusions Use of mH ealth tools identifies patients at high CVD risk in their home, increases the likelihood of participating in chronic CVD risk factor management, and strengthens referrals. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 02913339.

Effect of Telehealth Interventions on Blood Pressure Control

“…In the studies included in the meta-analysis, the duration of telehealth interventions was mostly in the range from 6 to 12 months. [18][19][20]23,27,28,[31][32][33][34][35][36] Based on the moderator analysis results in this study, we suggest that telehealth interventions should be applied for not more than a year.…”

“…The most important reasons involved in the occurrence of these results are the motivation loss in participants and the participant loss to follow-up as the duration of applying the intervention gets longer. In the studies included in the meta-analysis, the duration of telehealth interventions was mostly in the range from 6 to 12 months 18–20,23,27,28,31–36 . Based on the moderator analysis results in this study, we suggest that telehealth interventions should be applied for not more than a year.…”

Understanding the rise of cardiometabolic diseases in low- and middle-income countries

“…181 These strategies have usually been accompanied by training and technological support, leveraging mobile technology, and have been used mostly to diagnose or identify patients at risk. 152,182,183…”

Digital health interventions for non-communicable disease management in primary health care in low-and middle-income countries

“… Reviews: 38 , 49 Factors regarding the technological industry The development in technologies and infrastructures provide solid ground for digital health advancement, including penetration of cell phones and the internet. Reviews: 23 , 24 , 26 , 28 , 30 , 38 , 41 , 44 , 47 , 49 , 51 , 55 Trials: 55 , 56 , 58 , 63 Technical constraints (e.g., cell phone unavailability, internet instability) in marginal and remote regions limit the coverage of digital health. Reviews: 34 , 44 , 47 , 49 Trials: 65 , 68 , 70 Some unresolved data-related technical issues prohibit further uptake of digital health, including data security issues and data ownership issues.…”